Gastric reduction apparatus and related methods

ABSTRACT

The invention relates to a method and apparatus for endoscopically shaping and standardizing the size of a sleeved stomach for use in gastric reduction surgery. The device and method standardize and streamline gastric reduction surgery, specifically vertical sleeve gastrectomy, providing a guide for creating the stomach reduction and also shaping a stomach which will maintain an appropriate structure post-surgery.

CROSS-REFERENCE TO RELATED APPLICATIONS

None.

STATEMENT OF FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

None.

REFERENCE TO A SEQUENCE LISTING, A TABLE, OR A COMPUTER LISTING COMPACTDISC APPENDIX

None.

BACKGROUND OF THE INVENTION

The present invention relates to gastric reduction surgery, specificallyvertical sleeve gastrectomy. The invention relates to a method andapparatus for endoscopically shaping and standardizing the size of asleeved stomach.

Morbid obesity is a serious medical condition increasing in incidence inthe United States and world-wide. Morbid obesity with and without itscomorbidities markedly decreases life expectancy. Surgical treatment formorbid obesity has proven to be the only effective and durable method oftreatment and is far superior to medical interventions.

Many surgical interventions have been developed to treat morbid obesityand its comorbidities. The field of bariatric and metabolic surgery hasevolved and continues to evolve as some surgical treatments have beenfound to be less effective than others. Some of the older methods thathave become less popular include the Vertical Banded Gastroplasty,Non-adjustable gastric band and the adjustable LapBand. The moreeffective and more commonly performed surgeries today include theVertical Sleeve Gastrectomy, Roux-en-Y Gastric Bypass andBiliopancreatic Diversion with a Duodenal Switch. In 2017 approximately228,000 bariatric surgeries were performed in the United States alone.Of those surgeries, more than 59% were the Vertical Sleeve Gastrectomy.It is estimated that an additional 3.5% of the surgeries performed alsohave a sleeved stomach as part of the surgery as is the case with theBiliopancreatic Diversion with a Duodenal Switch. The Vertical SleeveGastrectomy has overtaken the Roux-en-Y Gastric Bypass as the mostcommonly performed bariatric surgery world-wide.

The Vertical Sleeve Gastrectomy involves removing approximately 70% ofthe stomach along the greater curvature, resulting in a relativelytubular shaped upper stomach with preservation of the antrum. This isaccomplished via stapling the stomach in a relatively straight fashionstarting from the antrum and heading to angle of His and then removingthe sleeve gastrectomy specimen which would include the majority of thebody and fundus of the stomach. There is no bypassing of intestine inthe standard Vertical Sleeve Gastrectomy.

Sleeving the stomach may sound to be a relatively simple matter, howeverif done incorrectly, can result in serious complications such asstricture resulting in intractable nausea and vomiting and reflux,twisting of the staple line which can result in folding of the sleevedstomach upon itself, misaligned staple lines which can result incatastrophic leaks. Surprisingly and unfortunately, even though theVertical Sleeve Gastrectomy has become the most commonly performedbariatric operation in the world, the manner in which a stomach issleeved is not standardized. Bougie sizes used to shape the sleeve rangefrom 32 to 40 French. Some surgeons use devices utilizing suction andsome not and the amount of antrum preserved is highly variable. It isbasically dealers' choice with no standardization.

Experienced surgeons proficient in performing Vertical SleeveGastrectomy however agree upon certain key points when creating a sleevestomach. Relatively larger bougie sizes should be utilized in order toprevent stricture. Care should be taken to keep the upper portion of thesleeved stomach as straight and tubular as possible with equal amountsof stomach preserved anteriorly and posteriorly in order to preventtwisting of the staple line and stricturing. The majority of the antrumshould be preserved to prevent dysphagia.

This is a problem that has not been successfully solved by currentdevices or methods. Devices such as McCarty (U.S. Pat. No. 9,987,157)are not standardized to maintain the needed portions of the patient'sstomach, such as the antrum, by temporarily attaching to the inner wallsof the stomach as in the claimed invention. Additionally, other devicesand methods still require a separate guide mechanism as in Thompson etal. (U.S. Ser. No. 14/846,764) and Thompson et al. (U.S. Pat. No.9,724,096). The claimed invention solves these problems by integrating,in a single device and streamlined method, an attachment method topreserve critical portions of the stomach while also providing a guideto for performing a gastrectomy.

Because of the serious complications that can result from misshapedsleeves, it is desirable to provide instruments and methods that willhelp to position and orient the stomach in order to create astandardized shape and size for a properly formed consistently shapedsleeved stomach. The present invention provides an instrument and methodfor assisting in the performance of a standardized Vertical SleeveGastrectomy resulting in reduced patient morbidity.

SUMMARY OF THE INVENTION

The object of the present invention is to provide an inflatable,articulating, adjustable endoscopic instrument for properly shaping thestomach in order to standardize the shape and preserve the antrum of thestomach as well as prevent stricture and prevent twisting of the stapleline during stapling of the stomach while creating a Vertical SleeveGastrectomy. Intra-operative measurements of 500 decompressed stomachswhere made in order to ascertain the average dimensions from thegastroesophageal junction to the angularis incisura, the angularisincisura to the antrum on the greater curvature, and from the angularisincisura to the pylorus.

In one embodiment the claimed invention is a method of treating apatient, comprising the steps of inserting a gastric reduction surgeryassistance apparatus through the patient's mouth and into theiresophageal tract; deploying a balloon from a cylindrical outer sheath ofthe gastric reduction surgery assistance apparatus to extend into thepatient's stomach; inflating the balloon within the patient's stomach;engaging the plurality of hollow channels of the balloon to seal againstthe patient's stomach's inner walls; excising the excess stomach andclosing the patient's stomach; removing the gastric reduction surgeryassistance apparatus.

In one embodiment, the deploying step may comprise deploying a balloonfrom the distal end of the cylindrical outer sheath of the gastricreduction surgery assistance apparatus into the patient's stomach. Inanother embodiment, the cylindrical outer sheath may be inserted intothe patient's stomach. In this embodiment, the balloon may be deployedby retracting the cylindrical outer sheath, exposing the balloon. Theballoon may be comprised of an inflatable material such as rubber,latex, polychloroprene, or nylon. In one embodiment, the inflating stepmay comprise inflating the balloon with a gas or a liquid to between 35and 45 French at the proximal 8 to 12 centimeters of the balloon. Thegas may be any gas such as oxygen or nitrogen. The liquid may be anyfluid liquid such as water or saline. Further, the inflating step mayfurther comprise inflating a balloon cylindrical member having a lengthof 13 to 17 centimeters and wherein the distal 3 to 7 centimeters of theballoon cylindrical member angles from to between 130 and 140 degreesaligning with the lesser curvature of the stomach and extending into theantrum of the stomach. In one embodiment, the angle may be inherent inthe balloon shape and angle on inflation. In another embodiment, theballoon may be inflated and then manually angled to fit against thelesser curvature of the patient's stomach. In either angling embodiment,the balloon angle may be tailored to fit against a plurality of sizes ofpatient stomach's and lesser curvatures.

In one embodiment, the inflating step further comprises inflating theremaining distal 3 to 7 centimeters of the balloon into a bell shapewith the proximal end inflated to 35 to 45 French and the distal endinflated to 145 to 155 French.

In one embodiment, the engaging step comprises engaging the plurality ofhollow channels wherein a negative pressure is applied through thehollow channels, sealing the balloon against the lesser curvaturelateral, anterior, and posterior internal walls of the patient'sstomach. In a preferred embodiment, the hollow channels will engage thelateral lesser curvature side, the anterior side, and the posterior sideof the patient's stomach. By engaging the three sides of the patient'sstomach and pulling the anterior side and posterior side together, a newgreater curvature of the stomach may be formed.

In one embodiment, the excising step comprises removing the excessgreater curvature lateral stomach not sealed to the balloon and sealingthe patient's stomach together around the balloon. The excising may beperformed by cutting with a sharp utensil such as a laparoscopic knife.The sealing may be performed by stapling or suturing with tools such asa surgical stapling device. In a preferred embodiment, the balloon edgemay be used as a guide for cutting. By doing so, there is less room foruser error in the excision step and the excision may be standardized. Inone embodiment, the greater curvature lateral edge of the balloon mayhave further guide assistance. In one embodiment, this guidance may beillumination such as light emitting diodes (LEDs) placed on the balloonto guide a surgeon in excising the stomach along the edge of theballoon. In another embodiment, this guidance may be a rough edge ortexture of the balloon to guide a surgeon in excising the stomach alongthe edge of the balloon.

In a preferred embodiment, the removing step comprises disengaging thesuction of the plurality of hollow channels then deflating the balloonthereby unsealing the balloon from the internal lining of the patient'sstomach. The new shape of the stomach is maintained after deflating theballoon and a new greater curvature now exists. The removing stepfurther comprises removing the gastric reduction surgery assistanceapparatus and deflated balloon through the patient's esophageal tractand out through the patient's mouth.

In one embodiment, the claimed invention is a gastric reduction surgeryassistance apparatus comprising an outer sheath inserted into thepatient's esophageal tract; an inflatable and deflatable ballooncylindrical member capable of being deployed and retracted from saidouter sheath comprising hollow channels opening on the exterior surfaceof the balloon and converging to one channel within the balloon. In oneembodiment, the length of the balloon cylindrical member is between 13and 17 centimeters. In one embodiment, the distal 3 to 7 centimeters ofthe member is angled when inflated to between 130 and 140 degreesaligning with the antrum of the patient's stomach.

In one embodiment, the balloon is inflated and deflated by an inflationtube running from the balloon cylindrical member through the outersheath and out of the patient where inflation and deflation arecontrolled by an inflation pump. In one embodiment, the proximal 8 to 12centimeters of balloon is between 35 and 45 French when inflated withthe remaining 3 to 7 centimeter distal end of the balloon inflated to abell shape of 35 to 45 French at its proximal end and 145 to 155 Frenchat its distal end. The balloon is inflated by an inflation pump using agas or a liquid.

In one embodiment, the balloon comprises a plurality of hollow channelsopening on the exterior of the balloon and converging to one channelwithin the outer sheath with that one channel continuing as a hollowtube running through the outer sheath and out of the patient where anegative pressure may be applied and controlled by a suction pump. Byconverging to one channel within the balloon, pressure applied to thisone channel will then be extended to the plurality of channels openingon the outer edge of the balloon. In a preferred embodiment, the hollowchannels increase in diameter as the balloon inflates, facilitating moreefficient pressure transfer. In a preferred embodiment, the balloon isinflated when pressure is applied to the channel within the balloon,thereby better facilitating pressure transfer to the plurality of hollowchannels because they will be supported by the balloon's inflation.

In a preferred embodiment, the method of performing gastric reductionsurgery using an assistance device as claimed can be used to standardizegastric reduction surgery. By standardizing the method of performing thesurgery, the surgery can be performed with fewer errors orcomplications, thereby increasing surgery success rates and increasingpatient quality of life.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features, aspects, and advantages of the presentinvention will become better understood with regard to the followingdescriptions, appended claims, and accompanying drawings where:

FIG. 1 shows the insertion of the device through the patient's mouth.

FIG. 2A shows the device in an uninflated state.

FIG. 2B illustrates the balloon protruding from the outer sheath.

FIG. 2C depicts the inflated balloon with a plurality of hollow channelsopening on the outer edge of the balloon.

FIG. 2D depicts the network of hollow channels converging to a centralhollow channel in the balloon.

FIG. 3 shows the device as it continues to inflate and details the innerchannels of the balloon.

FIG. 4 depicts the balloon as it continues to inflate.

FIG. 5 shows the fully inflated balloon within the patient's stomach.

FIG. 6 shows the fully inflated device within the patient's stomach.

FIG. 7 shows the removal of the greater curvature of the patient'sstomach while the device continues to be fully inflated within thepatient's stomach.

FIG. 8 depicts the deflation and removal of the device.

FIG. 9 shows the removal of the device through the patient's esophagealtract and mouth.

DETAILED DESCRIPTION OF THE INVENTION

In the Summary of the Invention above and in the Detailed Description ofthe Invention, and the claims below, and in the accompanying drawings,reference is made to particular features of the invention. It is to beunderstood that the disclosure of the invention in this specificationincludes all possible combinations of such particular features. Forexample, where a particular feature is disclosed in the context of aparticular aspect or embodiment of the invention, or a particular claim,that feature can also be used, to the extent possible, in combinationwith and/or in the context of other particular aspects and embodimentsof the invention, and in the invention generally.

All of the compositions and/or methods disclosed and claimed herein canbe made and executed without undue experimentation in light of thepresent disclosure. While the compositions and methods of this inventionhave been described in terms of preferred embodiments, it will beapparent to those of skill in the art that variations may be applied tothe compositions and/or methods and in the steps or in the sequence ofsteps of the method described herein without departing from the concept,spirit, and scope of the invention. All such similar substitutes andmodifications apparent to those skilled in the art are deemed to bewithin the spirit, scope, and concept of the invention as defined by theappended claims.

The term “comprises” and grammatical equivalents thereof are used hereinto mean that other components, ingredients, steps, etc. are optionallypresent. For example, an article “comprising” (or “which comprises”)components A, B, and C can consist of (i.e., contain only) components A,B, and C, or can contain not only components A, B, and C but also one ormore other components.

Where reference if made herein to a method comprising two or moredefined steps, the defined steps can be carried out in any order orsimultaneously (except where the context excludes that possibility), andthe method can include one or more other steps which are carried outbefore any of the defined steps, between two of the defined steps, orafter all the defined steps (except where the context excludes thatpossibility).

The term “at least” followed by a number is used herein to denote thestart of a range beginning with that number (which may be a range havingan upper limit or no upper limit, depending on the variable beingdefined). For example, “at least 1” means 1 or more than 1. The term “atmost” followed by a number is used herein to denote the end of a rangeending with that number (which may be a range having 1 or 0 as its lowerlimit, or a range having no lower limit, depending upon the variablebeing defined). For example, “at most 4” means 4 or less than 4, and “atmost 40%” means 40% or less than 40%. When, in this specification, arange is given as “(a first number) to (a second number)” or “(a firstnumber)-(a second number),” this means a range whose lower limit is thefirst number and whose upper limit is the second number. For example, 25to 100 mm means a range whose lower limit is 25 mm, and whose upperlimit is 100 mm.

As shown in FIGS. 1, 2A, and 2B, one embodiment of the claimed gastricreduction surgery assistance apparatus and methods applied to a patient140 comprises an insertion tube 100 that is inserted into the patient'smouth 142 and into their esophageal tract 144. In a preferredembodiment, the insertion tube 100 comprises a cylindrical outer sheath112. The cylindrical outer sheath 112 is comprised of rigid orsemi-rigid material that is non-toxic. Contained in the cylindricalouter sheath 112 is a balloon 110 in a deflated state. In a preferredembodiment, the balloon 110 is comprised of a collapsible material suchas rubber or latex, capable of maintaining a rigid structure wheninflated.

As depicted in FIGS. 1, 2A, and 2B, in a preferred embodiment, thecylindrical outer sheath 112 is inserted down the patient's esophagealtract 144 until the distal end of the cylindrical outer sheath 112reaches through the patient's esophageal sphincter 154. In a preferredembodiment, at least one inflation controlling channel 104 of theballoon 110 will extend from the proximal end of the cylindrical outersheath 122, through the patient's esophageal tract 144, and out of thepatient's mouth 142. The channel can be sealed to and controlled by aninflation pump outside of the patient's mouth 142. In one embodiment,the pump can pump gas or liquid to fill the balloon 110 within thepatient's stomach 150. In a preferred embodiment, the cylindrical outersheath 112 slides up, exposing the balloon 110. The cylindrical outersheath 112 may be slid up by mechanical means such as an attached linerunning to outside of the patient, or by the force of the balloon 110inflating.

In a preferred embodiment, at least one suction controlling channel 102will extend from the proximal end of the cylindrical outer sheath 122,through the patient's esophageal tract 144, and out of the patient'smouth 142. The suction controlling channel can be sealed to a suctionpump or negative pressure pump outside of the patient's mouth 142. In apreferred embodiment, the suction pump or negative pressure pump willapply negative pressure through the suction controlling channel 102 andto the plurality of hollow channels that open on the outer edges of theballoon 108 in the patient's stomach 150.

As shown in FIGS. 2A, 2B, 2C, 2D, and 3 , in one embodiment, the balloon110 comprises a plurality of hollow channels that open on the outeredges of the balloon 108 and converge to one channel within the balloon106. In one embodiment, the converged channel 106 is connected to asuction controlling channel 102 outside of the patient's body that canbe engaged once the balloon 110 is inflated. In one embodiment, thehollow channel openings 108 are circular in shape allowing temporarysuction attachment to a patient's interior stomach wall. In anotherembodiment, the hollow channel openings 108 may be another shape,allowing tailored temporary suction attachment to a patient's interiorstomach wall. In one embodiment, the hollow channel openings 108 may beuniformly spaced and patterned on the outer edges of the balloon. Inanother embodiment, the hollow channel openings 108 may be scatteredrandomly over the outer edges of the balloon to allow better temporarysuction attachment to a plurality of stomach shapes. In yet anotherembodiment, the hollow channel openings 108 may be spaced over the outeredges of the balloon such to optimize specific temporary suctionattachment to a plurality of stomach shapes.

In a preferred embodiment, the plurality of hollow channel openings 108are grouped on the outer surface of the balloon 110 to primarily applysuction and temporarily attach to the posterior, anterior, and laterallesser curvature of the patient's stomach. In one embodiment, toaccomplish this, hollow channel openings 108 are only present on theposterior, anterior, and lateral left curvature outer edges of theballoon 108. In another embodiment, larger diameter hollow channelopenings 108 are present on the posterior, anterior, and lateral leftcurvature outer edges of the balloon 108 while smaller diameter hollowchannel openings 108 are present on the lateral greater curvature outeredge of the balloon 108, thereby facilitating a stronger temporaryconnection to the posterior, anterior, and lateral lesser curvatureouter edges of the balloon 108 and a weaker temporary connection to thelateral greater curvature outer edge of the balloon 108.

As shown in FIGS. 2B, 2C, 2D, and 3 , in one embodiment, when theinflation pump is engaged and the balloon 110 is inflated, the balloon110 extends out of the cylindrical outer sheath 112, through thepatient's esophageal sphincter 154, and into the patient's stomach 150.In another embodiment, the distal end of the cylindrical outer sheath120 extends through the esophageal sphincter 154 and allows the balloonto only extend out into the patient's stomach 150. In a preferredembodiment, the cylindrical outer sheath 112 is slid up the suctioncontrolling channel 102 and the inflation controlling channel 104 toexpose the balloon 110 within the patient's stomach 150. The balloon 110extends out of the cylindrical outer sheath 112 and maintains acylindrical shape. In one embodiment, the proximal end of the inflatedballoon 304 is between 8 and 12 centimeters in length and 35 and 45French in width. In a preferred embodiment, the proximal end of theinflated balloon 304 is 10 centimeters in length and 40 French in width.

As further depicted in FIG. 3 , as the balloon is inflated, the distalend of the inflated balloon 306 forms a shape that angles to between 130and 140 degrees 300 on the inner angle. In a preferred embodiment, theangle of bend is 135 degrees 300. In one embodiment, the distal end ofthe inflated balloon 306 is between 3 and 7 centimeters in length. In apreferred embodiment, the distal end of the inflated balloon 306 is 5centimeters in length.

Specifically shown in FIG. 3 , in one embodiment, an angling assistancedevice 308 may be inserted down and through the converged channel 106.In one embodiment, the angling assistance device 308 may be a thin rigidstructure, such as a wire, that is angled to manipulate the distal endof the inflated balloon 306.

As shown in FIG. 4 , as the balloon 110 continues to inflate, in oneembodiment, the final inflated form of the distal end of the inflatedballoon 306 forms a bell shape 400. In one embodiment, the proximal endof the bell shape 402 is between 35 and 45 French in width. In oneembodiment, the distal end of the bell shape 404 is between 145 and 155French in width. In a preferred embodiment, the proximal end of the bellshape 402 is 40 French in width and the proximal end of the bell shape404 is 150 French in width. FIG. 5 shows one embodiment of the fullyinflated balloon 110 within the patient's stomach 150.

As shown in FIG. 5 , the bell shape 400 of the inflated balloon 110follows the lesser curvature lateral side of the patient's stomach 150and extends into the stomach's antrum 506. In one embodiment, the bellshape 400 of the inflated balloon 110 stops at the stomach's antrum 506and does not extend past into the patient's pyloric canal 504 or pyloricsphincter 502. In another embodiment, the bell shape 400 of the inflatedballoon 110 may extend further into the patient's pyloric canal 504 orto the pyloric sphincter 502, depending on patient stomach size.

As shown in FIG. 6 , once the balloon 110 is fully inflated within thepatient's stomach 150, the suction controlling channel within theballoon 106 can be engaged. Once engaged, the suction controllingchannel within the balloon 106 applies negative pressure to theplurality of hollow channel openings 108 on the outer edges of theballoon. In one embodiment, this negative pressure temporarily affixesthe inflated balloon 110 to the lesser curvature 602 of the patient'sstomach 150. In a preferred embodiment, the inflated balloon 110 istemporarily affixed to the lateral lesser curvature 602, anterior, andposterior walls of the patient's stomach 150.

As shown in FIG. 6 , once the suction controlling channel within theballoon 106 applies negative pressure to the plurality of hollow channelopenings 108 on the outer edges of the inflated balloon, in oneembodiment, the greater curvature 600 of the patient's stomach 150 isleft loose and unaffixed to the balloon 110. In a preferred embodiment,the greater curvature 600 of the patient's stomach 150 may then beexcised from the rest of the stomach, thereby performing a gastricreduction. Excision may be performed by any standard method in thegastric reduction practice, including but not limited to stapling alonglateral edge formed by the balloon 110 and then cutting the excessgreater curvature 600 with laparoscopic knife, thereby forming a newgreater curvature 700. In a preferred embodiment, the lateral greatercurvature is used as a guide for stapling the patient's stomach 150 tocreate a new greater curvature 700 along the edge of the balloon 110,and thereby standardizing the gastrectomy procedure.

As shown in FIGS. 6 and 7 , in a preferred embodiment, the greatercurvature 600 of the patient's stomach 150 is excised by cutting thestomach along the inflated balloon 604. In a preferred embodiment, oncethe greater curvature 600 of the patient's stomach 150 is excised, theanterior and posterior portions of the remaining stomach may be sealedtogether along the edge of the inflated balloon 604, thereby completinga gastric reduction in size to the patient's stomach 150. The sealing ofthe anterior edge of the stomach to the posterior edge of the stomachforms a new, smaller greater curvature 700. The sealing may be performedby any standard method in the gastric reduction practice, including butnot limited to stapling or suturing.

In one embodiment, by sealing the smaller greater curvature along theedge of the inflated balloon 604, standardization of the gastricreduction surgery can be achieved in which the stomach's antrum 506 ispreserved. In a preferred embodiment, the edge of the inflated balloon604 acts as a guide to the surgeon, allowing for a uniform method ofsealing and performing gastric reduction surgery by creating a smallergreater curvature 700 of the patient's stomach.

Once the sealing has been completed and the smaller greater curvature700 has been formed, in a preferred embodiment, the apparatus may beremoved.

FIGS. 8 and 9 show the removal of the claimed apparatus. Once thesealing has been performed, the suction pump or negative pressure pumpof the suction controlling channel 102 may be disengaged, therebyreleasing the negative pressure to the plurality of hollow channelopenings 108 on the outer edges of the inflated balloon 110. In apreferred embodiment, this allows the balloon to un-affix itself fromthe walls of the patient's stomach 150. Once the negative pressurethrough the suction control channel 102 and hollow channel openings 108has been removed, in one embodiment, the inflation pump may bedisengaged from the inflation controlling channel 104, thereby releasingthe air or gas from the balloon 110 and out of the proximal end of theinflation controlling channel 104 outside of the patient's body. Inanother embodiment, the inflation pump may be capable of activelyapplying negative pressure to deflate the balloon 110 through theinflation controlling channel 104.

In one embodiment, once the balloon 110 has been deflated, the balloon110 may be pulled back up through the patient's esophageal sphincter 154by pulling the inflation controlling channel 104 and the suctioncontrolling channel 102 attached to the insertion tube 100 and balloon110. In another embodiment, a line may be attached to the insertion tube100 or cylindrical outer sheath 112 to be used for retrieving the entireapparatus once the balloon 110 is deflated. In the preferred embodiment,the entire apparatus is pulled up through the patient's esophageal tract144 and out of the patient's mouth 142, completing removal. In oneembodiment, the entire apparatus may be removed once the balloon 110 isfully deflated and the inflation controlling channel 104 is capped. Inanother embodiment, the entire apparatus may be removed once theinflation pump is disengaged from the inflation controlling channel 104and the gas or liquid is released, as least partially deflating theballoon 110.

What is claimed is:
 1. A gastric reduction surgery assistance apparatuscomprising: a cylindrical sheath including a proximal end and a distalend; and a balloon member including: a balloon configured to beretractable into the cylindrical sheath, a converged channel within theballoon, a plurality of channel openings extending through the balloonfrom the converged channel, an inflation controlling channel forinflating the balloon, and a suction controlling channel for applyingnegative pressure to the converged channel and the plurality of channelopenings, wherein the suction controlling channel is connected to theconverged channel; wherein the balloon is configured to be deployablefrom the distal end of the cylindrical sheath.
 2. The gastric reductionsurgery assistance apparatus of claim 1, wherein the length of theballoon is between 13 and 17 centimeters.
 3. The gastric reductionsurgery assistance apparatus of claim 2, wherein a distal end of theballoon is angled when inflated to between 130 and 140 degrees.
 4. Thegastric reduction surgery assistance apparatus of claim 3, wherein thedistal end of the balloon is a distal 3 to 7 centimeters of the balloon.5. The gastric reduction surgery assistance apparatus of claim 3,wherein the distal end of the balloon is a bell shape.
 6. The gastricreduction surgery assistance apparatus of claim 1, further comprising apump.
 7. The gastric reduction surgery assistance apparatus of claim 6,wherein the pump is a suction pump, an inflation pump, or both.
 8. Thegastric reduction surgery assistance apparatus of claim 1, wherein whenthe balloon is inflated, a proximal 8 to 12 centimeters of the balloonis between 35 and 45 French, and a distal 3 to 7 centimeters of theballoon is a bell shape including a proximal end and a distal end,wherein the proximal end of the bell shape is 35 to 45 French and thedistal end of the bell shape is 145 to 155 French.
 9. The gastricreduction surgery assistance apparatus of claim 1, further comprising anangling assistance device.